Nomination to receive the Commuted Value of Pension

Nomination to receive the commuted value of Pension in the event of death of a Government employee

(Introduced in G.O. Ms. No . 888 Finance, dated 20.10.87)

Head office

(Place) ………………………….

I, hereby nominate the person (Name of the pensioner in capital letters).

Named below, for receiving commuted value of pension

Name and address Of the Nominee	Relationship with pensioner	If nominee is minor
Name and address Of the Nominee	Relationship with pensioner	Date of Birth	Name and address of person who may receive the said commuted value during the nominees minority
(1)	(2)	(3)	(4)

Name and address of other nominee in case the nominee under Col(1) above predeceases the pensioner

Relationship with pensioner

Date of birth if nominee is minor

Name and address of person who may receive the said commuted value of pension during the nominees minority

Contingency on happening of Which nomination shall become Invalid

(5)

(6)

(7)

(8)

(9)

Place & Date :

Witness Signature or thumb impression

Signature : Address

Name :

Address : Signature of Head of Office

Acknowledgement to be sent by the Head of Office.

Certified that the nomination has been received from…………………… (Name of Pensioner) whose address is……………………………………………

Place: Signature of Head Office

Date: Full Address

Note : For the purpose of nomination, family members as defined in rule 45(5) of Tamil Nadu Rules, 1978 can be nominated.